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Semin Musculoskelet Radiol 2024; 28(04): 361-374
DOI: 10.1055/s-0044-1786151
Review Article

The Immature Pediatric Appendicular Skeleton

Jie C. Nguyen
1   Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
2   Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
,
Dennis Caine
3   Division of Education, Health and Behavior Studies, Kinesiology and Public Health Education, University of North Dakota, Grand Forks, North Dakota
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Abstract

Growth and maturation occur in a predictable pattern throughout the body and within each individual bone. In the appendicular skeleton, endochondral ossification predominates in long bones and growth plates. The ends of these long bones are sites of relative weakness in the immature skeleton and prone to injury from acute insult and overuse. We present the normal histoanatomy and physiology of the growth plate complex, highlighting the unique contribution of each component and shared similarities between primary and secondary complexes. Components of the growth plate complex include the physis proper, subjacent vascularity within the growth cartilage, and the ossification front. The second section describes imaging considerations and features of normal and abnormal growth. Finally, we review the Salter-Harris classification for acute fractures and offer examples of characteristic overuse injury patterns involving the epiphyseal (proximal humerus and distal radius), apophyseal (medial epicondyle and tibial tubercle), and secondary growth plate complexes (medial femoral condyle and capitellar osteochondritis dissecans). This article provides a foundation and basic framework to better understand and anticipate potential complications and growth disturbances and to ensure optimal follow-up and early intervention when treatment can be less invasive.

Keywords

growth distrubance - athlete - fracture - endochondral ossification - growth plate


Publication History

Article published online:
29 July 2024

© 2024. Thieme. All rights reserved.

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